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Archive for June, 2020

Sleep – Good Sleep Hygiene and Common Sleep Disorders. By Our Student Pharmacist, Madeline VanLoon.

Why do we sleep?

If the average person sleeps for approximately eight hours every night, it can be predicted that they will sleep for one-third of their life. This is time well spent, however. Sleep is essential for maintaining good health and prolonging life.

image 1

On an average night, we will cycle through different stages of sleep. Stages consist of Rapid Eye Movement (REM) sleep, and four non-REM stages of sleep. The deeper stages of sleep are restorative and critical for learning.

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What happens when we don’t sleep?

Sleep deprivation can lead to:

  • fatigue
  • depression
  • difficulty learning new things
  • high blood pressure
  • high blood sugar
  • cardiovascular disease
  • obesity
  • infections

Sleep deprivation can even shorten your overall lifespan. Daytime sleepiness can make you less productive, and also can be dangerous while driving or carrying out other daily tasks.

Good Sleep Hygiene

The best way to improve your sleep is to make sure that you are using “good sleep hygiene,” which is basically a set of good habits that prepare your body for a good night’s rest. The Centers for Disease Control and Prevention (CDC) recommends the following best practices:

  • Go to bed at the same time every night, including on the weekends.

  • Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.

  • Remove electronic devices such as TVs, computers, and smartphones from the bedroom.

  • Avoid large meals, caffeine, and alcohol before bedtime.

  • Increase your exercise. Being physically active during the day can help you fall asleep more easily at night.

Sleep Disorders – Insomnia

Insomnia is defined as a dissatisfaction with sleep quantity or quality, complaints of poor daytime functioning, and at least one of the following: difficulty falling asleep, difficulty staying asleep, or waking up early in the morning with the inability to return to sleep. These conditions must occur at least three nights per week, for at least three months, despite good sleep hygiene and no known other causes. Certain medications and medical conditions can cause insomnia.

Treating insomnia

  • First, resolve any underlying causes for insomnia.

  • Next, use non-drug treatment options, including good sleep hygiene.

  • Talk to your doctor or pharmacist about over-the-counter sleep aids.

  • NOTE: Data shows that medications to help insomnia are only modestly helpful, and may carry more risks than benefits. Be cautious while taking these medications.


  • Avoid using alcohol to help you sleep – it may fragment your sleep, and chronic use may lead to dependence.

  • Avoid antihistamines such as diphenhydramine (Benadryl) and doxylamine (Unisom) if you are over 65. You may be more susceptible to dry mouth, confusion, constipation, dizziness, and fatigue.

  • Avoid long term use of antihistamines to sleep – tolerance may develop in 4-7 days of daily use, and may not continue working for you after that.

  • Melatonin may help regulate circadian rhythm, but it is not FDA regulated.

Sleep Disorders – Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a condition where breathing while sleeping is stopped periodically throughout the night due to a blockage in the upper airway. This condition results in an extensive list of daytime and nighttime symptoms, including:

Daytime Symptoms of OSA:

  • Sleepiness

  • Fatigue

  • Aches

  • Dry mouth

  • Nasal congestion

  • Depression

  • Erectile dysfunction

  • Cognitive impairment

Nighttime Symptoms of OSA:

  • Disrupted sleep

  • Loud snoring

  • Snorts and gasps

  • Frequent awakenings

  • Increased nighttime urination

While these are all uncomfortable symptoms, the most concerning consequence of OSA is the risk of heart problems like heart failure and irregular heartbeat.

Risk Factors for OSA

If you have three of the following eight risk factors for OSA, you may be at high risk for developing the condition:

  • Snoring

  • Tired

  • Observed while breathing stopped

  • High blood pressure

  • BMI greater than or equal to 35

  • Age over 50

  • Neck circumference (distance around neck) greater than 40 cm

  • Male gender

image 3

Treatment for OSA

The best treatment for OSA is using a Continuous Positive Airway Pressure (CPAP) machine every night. The machine allows the airway to remain open, allowing for consistent breathing throughout the night, and is superior to treatment with medications. If you believe you are experiencing OSA, talk to your doctor about treatment options.


CPAP side effects. Sleep Association. https://www.sleepassociation.org. Accessed June 22, 2020.

Explain that insomnia meds are only modestly effective. Pharmacist’s Letter. 2020. https://pharmacist.therapeuticresearch.com. Accessed June 23, 2020.

Management of obstructive sleep apnea in adults. UpToDate. Wolters Kluwer. Available at https://www.uptodate.com. Accessed June 22, 2020.

Obstructive sleep apnea and cardiovascular disease in adults. UpToDate. Wolters Kluwer. Available at https://www.uptodate.com. Accessed June 22, 2020.

Pathophysiology of obstructive sleep apnea in adults. UpToDate. Wolters Kluwer. Available at https://www.uptodate.com. Accessed June 22, 2020.

Sleep and sleep disorders: tips for better sleep. Centers for Disease Control and Prevention. https://www.cdc.gov/sleep/. Accessed June 22, 2020.

Sleep Apnea Information Page. National Institute for Neurologic Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Sleep-Apnea-Information-Page. Accessed June 22, 2020.


  1. https://ideepsleep.com/tips-to-try-for-a-peaceful-sleep/

  2. https://www.sleepassociation.org/about-sleep/what-is-sleep/

  3. https://www.terrycralle.com/best-cpap-machines/

National HIV Testing Day- June 27. By Our Student Pharmacist, Stephanie Brokaw.



Although there still is not a vaccine available to prevent the transmission of HIV or a cure for the disease, many advancements have been made in terms of testing, treatment, and taking medications to prevent contraction of the disease.

Since 1995, June 27 has been marked as National HIV Testing Day in an effort to encourage people to get tested, know their status, and seek treatment or preventative care if applicable1.

HIV is most commonly transmitted through unprotected sexual activity or needle/syringe use2. HIV can live in a used needle up to 42 days depending on temperature and other factors2.

In 2018, there were 37,968 people newly diagnosed with HIV in the United States and there are an estimated 1.2 million people living with HIV in the United States2.


If you are sexually active, you should get tested at least once a year for all STDs, including HIV2. Testing is the only way to know your true status of whether you are HIV positive or negative2. HIV testing is covered by your health insurance for no co-pay as required by the Affordable Care Act and some testing sites may offer free tests to those who do not have insurance2.


There are three types of test available:

  • nucleic acid test
  • antigen/antibody tests
  • antibody tests

The nucleic acid test is not routinely used for screening because of cost2.

The antigen/antibody test is performed by drawing blood from a vein or a finger prick2.

The HIV antibody test can be conducted with blood from a vein or fingerstick or from oral fluids2.

Most results can be seen within 30 minutes to 2 hours, but some tests may take up to 2 days2. No test can detect HIV immediately after infection; most tests can detect HIV 23 days or more after exposure2. If you believe you were exposed to HIV, post exposure prophylactic medication can be taken (start within 72 hours of exposure) to reduce the risk of contracting the disease2.

If you do not wish to go to a clinic for testing, you can perform testing at home with a rapid self-test called OraQuick, which is available upon request next business day at any of our pharmacies for $43.29.

 Columbus Resources

Free HIV testing is available at many clinics in Columbus. You can find a clinic near you using this link. Due to the coronavirus pandemic, many testing sites may be by appointment only, so make sure you call ahead.






Using Opioid Narcotics: Safety Tips and Using Narcan ® (Naloxone). By Our Student Pharmacist, Madeline VanLoon.

Opioids are a class of medication that include heroin, as well as prescriptions medications such as:

  • morphine
  • codeine
  • methadone
  • oxycodone (Oxycontin, Percocet)
  • hydrocodone (Vicodin, Norco)
  • fentanyl (Duragesic), hydromorphone (Dilaudid)
  • buprenorphine (Subutex, Suboxone).

Opioids are extremely effective in controlling pain; however, they also carry risks such as significant constipation, physical dependence, and respiratory depression. Respiratory depression is also known as an “opioid overdose,” and occurs when breathing slows or stops, leading to death. This is why it is important to be careful when using these medications.

image 1 jpeg

What are the risks of an opioid overdose?

You are more likely to experience an opioid overdose if you:

  • Take 50 morphine milligram equivalents (MME) or more of prescribed opioids every day

  • Take opioid medications together with other sedating drugs, such as benzodiazepines and muscle relaxers

  • Have conditions such as lung disease, kidney dysfunction, liver dysfunction, or if you are HIV-positive

  • Have a decreased tolerance due to recent abstinence or break in therapy

  • Have a history of illicit substance use disorder

  • Have a history of overdose from opioids

  • Use any illicit drugs or have an opioid use disorder

How can an opioid overdose be prevented/stopped?

Avoid the risk factors listed above at all costs. If you are prescribed opioid medications by a physician, it is important to take them as sparingly as possible, and no more than prescribed. If you have a substance use disorder, talk to your doctor about seeking treatment.

In an overdose, Narcan ® (naloxone) is a medication that rapidly reverses the effects of opioids long enough to call an ambulance. The Centers for Disease Control and Prevention (CDC) recommends that naloxone be provided to all patients who have or know someone with risk factors for opioid overdose. Extensive administration education is provided to all who receive the medication.

image 2

Overview of naloxone:

Naloxone (nal-OKS-one) blocks the effects of opioids on the brain and restores breathing. It is safe to give to anyone who is experiencing a known or suspected overdose caused by opioids. It has very few side effects and drug interactions. It will produce withdrawal symptoms. In situations where an overdose was caused by non-opioid drugs, naloxone will not be effective.

Naloxone only lasts 30-60 minutes in the body, but opioid medications typically last much longer. That is why it is so important that if someone receives naloxone, emergency medicine services (9-1-1) are called and that they go to the hospital. As soon as naloxone wears off, the risk of overdosing returns.

Keep naloxone on hand if you or someone you know has risk factors for opioid-related overdose. It’s like having a fire extinguisher – hopefully you will not need to use it, but it can be the difference between life and death.

If you are at risk for opioid overdose, educate your family and others around you on how and when to use naloxone.

How do I get naloxone?

Naloxone can be accessed at many pharmacies and public health agencies. If you believe you or someone you know has risk factors for an opioid overdose, ask your pharmacist or health department about accessing naloxone.

How do I use naloxone and recognize an overdose?

  1. The signs of an overdose include:

    1. Slow breathing (less than 1 breath every 5 seconds) or no breathing

    2. Vomiting

    3. Pale and clammy face

    4. Blue lips or nails

    5. Slow heartbeat

    6. Snoring or gurgling noises

    7. Unresponsive

  2. Try to wake the person

  3. Call 9-1-1

  4. Make sure nothing is in the person’s mouth

  5. Give rescue breathing

  6. Use naloxone and continue rescue breathing

image 3 jpeg

  1. Turn the person on their side if the person begins breathing on their own. This is to avoid choking.

  2. Stay with the person until EMS arrives

Visit the State of Ohio Board of Pharmacy website for more information on administering naloxone.   https://www.pharmacy.ohio.gov/Pubs/NaloxoneResources.aspx


NARCAN nasal spray. ADAPT Pharma. https://www.narcan.com/. Accessed June 10, 2020.

Naloxone resources: pharmacist dispensing of naloxone. State of Ohio Board of Pharmacy.https://www.pharmacy.ohio.gov/Pubs/NaloxoneResources.aspx. Accessed June 10, 2020.

Prevention of lethal opioid overdose in the community. UpToDate. Wolters Kluwer. Available athttps://www.uptodate.com. Accessed June 9, 2020.

Streamline processes for providing naloxone. Pharmacist’s Letter. 2018.https://pharmacist.therapeuticresearch.com. Accessed June 9, 2020.


  1. https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/ohio-opioid-involved-deaths-related-harms

  2. https://www.narcan.com/

  3. https://www.narcan.com/


Staying Safe While Enjoying Summer. By Our Student Pharmacist, Stephanie Brokaw.

Precautions to Take During the Ongoing Covid-19 Pandemic:

As various businesses and recreational facilities begin and continue to open as we approach summer, it is important to remember that there are still new cases of COVID-19 and hospitalizations occurring related to the disease. Regardless of what activities you engage in this summer, it is important to keep in mind various safety tips needed to keep yourself and your families safe.

Some of these safety recommendations by the Centers for Disease Control and Prevention (CDC) include:

  • Continue to practice social distancing by staying at least 6 feet apart from people you do not live with.
  • Use facial coverings when possible, especially when maintaining 6 feet distances from other individuals may be difficult.
  • When visiting public spaces like restaurants, call ahead to make a reservation (when applicable) to avoid long wait times and increasing your exposure to other people who may be asymptomatic carriers of COVID-19.
  • If you experience symptoms of COVID-19, which include fever, cough, shortness of breath, or sore throat, avoid public places and public transportation.
  • Utilize services such as online ordering, delivery, and curbside pick-up for essential items or ask someone outside of your household who is not experiencing symptoms to obtain essential items for you and drop them off on your doorstep.
  • Wash your hands often especially after coughing and sneezing.
  • Clean high-touch surfaces daily.
  • It is safe to return to public spaces if you have been three days without a fever and symptoms have improved and ten days have passed since symptoms first appeared.

Pool Safety:

Some tips by the CDC specific to staying safe from COVID-19 in public swimming pools include:

  • Wash your hands before entering the facility and often during your visit.
  • Use facial coverings when possible (but do NOT use them while in the water, as it is difficult to breath through them when they are wet).
  • Although it has been shown COVID-19 cannot be spread through water, maintain a 6-foot distance from those in pools with whom you do not live.

Do not forget about other pool safety tips such as maintaining adequate hydration and protecting yourself from harmful UV radiation.

Ways to protect yourself from UV radiation include:

  • Cover your skin with clothing when possible. Darker colors may offer more UV protection than lighter colors.
  • When you cannot cover areas of the skin, use broad spectrum sunscreen of SPF 15 or higher. Reapply sunscreen every two hours or sooner if swimming or sweating. Some makeup and lip balms may also contain sun protective properties.
  • Wear a wide-brimmed hat that shades your face, ears, and back of neck. Darker colored hats may offer more protection. Avoid straw hats as they have holes that can permit sunlight to penetrate.
  • Wear sunglasses that block both UVA and UVB rays.


Outdoor Safety:

Physical activity is still very important to engage in despite the pandemic because of the positive effects associated with physical and mental health.

Some tips by the CDC specific for staying safe in parks and other outdoor recreational facilities include:

  • Visit parks close to your home to cut down on any unnecessary travel breaks which could put you at risk of encountering facilities or people who may be infected with COVID-19.
  • Before you leave, check if the park you are planning to visit has restroom facilities open. Regardless, use the restroom at your home before traveling to decrease contact with surfaces in public places. Carry hand sanitizer and disinfecting wipes into these public facilities whenever possible.


In addition to the sun protection methods above, when visiting outdoor recreational facilities, such as parks, it is important to protect yourself against bugs that can transmit disease such as mosquitos and ticks.

Ways to protect yourself include:

  • Cover your skin as much as possible.
  • Use an EPA-approved insect repellant.
  • Pre-treat clothing with permethrin.

Your community pharmacist is a great resource for more information regarding safety against COVID-19, UV radiation, and protection from mosquitos and ticks. Stop by one of our locations for more information and assistance in over-the-counter (OTC) product selection for your upcoming activities.





Photo references:




Shingles and Shingrix – What is it, and how can we prevent it? By Our Student Pharmacist, Madeline VanLoon.

What is “shingles”?

Shingles (herpes zoster) usually refers to an infection caused by the varicella zoster virus (VZV). It is the same virus responsible for chickenpox (varicella). Shingles typically manifests as a painful rash that forms where nerves from the spinal cord connect with the skin. This area is called a dermatome. The rash appears along a dermatome located on one side of the body. It is red, blistering, and can last up to thirty days. The pain associated with the rash is commonly described as “a deep burning,” “throbbing,” or “stabbing” sensation. Dermatomes are considered contagious until they dry and crust over (about 7 to 10 days after first symptoms appear). Scarring and changes in skin color at the lesion sites may occur.

Shingles - Mayo Clinic

The most common complication of shingles is postherpetic neuralgia (PHN), a condition characterized by persistent numbness, itching, and pain. This condition affects 10-15% of shingles patients and is defined by significant pain lasting for 90 days after onset of rash.

Are you at risk?

immune response after shingrix - Shingrix website

If you have had chickenpox, the virus that causes shingles is inside your body and can reactivate.

  • 99% of people over the age of 50 are living with the virus that causes shingles.

  • There are 1.2 million cases annually in the United States.

  • The risk is greatest in those whose immune system is weaker.

  • 1 in 3 people will get shingles in their lifetime, and your chances increase as you age.

  • 1 in 4 people will have a complication related to shingles. This could mean long term nerve pain, lasting months or even years after the rash has healed.

How do we treat shingles?

Shingles is treated with antiviral medications to enhance healing of skin lesions and decrease the severity of nerve pain. It is recommended to administer antiviral medications within 72 hours of the onset of symptoms for the most benefit. Pain relievers such as acetaminophen and NSAIDs (ibuprofen, naproxen) are used to manage mild to moderate pain. Other medications may be considered for treating associated skin infections and nerve pain in extreme cases.


Web MD Images

How can we prevent shingles?

Fortunately, a vaccine exists to prevent shingles. The vaccine, Shingrix, is a two-dose vaccine series recommended for those over the age of 50, even if they have previously been vaccinated with Zostavax. Shingrix is 90% effective at preventing shingles  – far superior to Zostavax, which has shown to be only 51% effective.

What should I know about the vaccine, Shingrix?

  • Shingrix is NOT a live vaccine. It is a recombinant vaccine with an adjuvant. It works to boost your body’s protection against shingles.

  • Complete vaccination with Shingrix requires two doses.The second dose should be received 2 to 6 months after the first dose. This is important to prevent shingles.

  • It is administered into the muscle of the upper arm.

  • Common side effects include pain, redness, swelling at the injection site, muscle pain, tiredness, headache, and flu-like symptoms. These effects should be temporary, and certainly far less severe than shingles itself.

What if I am immunocompromised ?

Being immunocompromised refers to having an immune system that is not working as well as it should as a result of advanced age, taking certain medications like steroids or chemotherapy, or other conditions such as HIV/AIDS. Low levels of immune system suppression are generally acceptable, but not all conditions have been evaluated by the Centers for Disease Control and Prevention (CDC) yet. Talk to your pharmacist to see if Shingrix is appropriate for you.


Epidemiology, clinical manifestations, and diagnosis of herpes zoster. UpToDate. Wolters Kluwer. Available at https://www.uptodate.com. Accessed June 4, 2020.

Answer questions about the new shingles vaccine Shingrix. Pharmacist’s Letter: 2018.https://pharmacist.therapeuticresearch.com. Accessed June 4, 2020.

Shingles Vaccine: FAQs. Pharmacist’s Letter. 2018. https://pharmacist.therapeuticresearch.com. Accessed June 4, 2020.

Shingrix (Zoster Vaccine Recombinant, Adjuvanted). GSK. https://www.shingrix.com/index.html. Published 2018. Accessed June 4, 2020.

Vaccination for the prevention of shingles (herpes zoster). UpToDate. Wolters Kluwer. Available athttps://www.uptodate.com. Accessed June 4, 2020.

What everyone should know about Zostavax. CDC. 2018.https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/. Accessed June 4, 2020.



  1. https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054#dialogId45719376

  2. https://www.shingrix.com/discover-shingrix.html

  3. https://www.webmd.com/skin-problems-and-treatments/shingles/ss/slideshow-shingles-pictures